Myrtle Street Obstetrics and Gynecology, PC

Key facts

NPI

1629344320

Entity type

Organization (NPI type 2)

Primary specialty

Obstetrics & Gynecology Physician 207V00000X

License

189300-1 (NY)

Legal business name

MYRTLE STREET OBSTETRICS AND GYNECOLOGY, PC

Practice address

2105 Ellsworth Blvd
Malta, NY 12020

Phone

(518) 587-2400

Fax

(518) 581-0141

NPI assigned

Mar 27, 2012

Organization subpart

No

Authorized official

Name

Ms. Louise West

Title

Practice Administrator

Phone

(518) 587-5304

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 27, 2012.

{
    "created_epoch": "1332806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332806400000",
    "number": "1629344320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 MYRTLE ST",
            "city": "SARATOGA SPRINGS",
            "state": "NY",
            "postal_code": "128661093",
            "telephone_number": "518-587-2400",
            "fax_number": "518-581-0141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 ELLSWORTH BLVD",
            "city": "MALTA",
            "state": "NY",
            "postal_code": "12020",
            "telephone_number": "518-587-2400",
            "fax_number": "518-581-0141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYRTLE STREET OBSTETRICS AND GYNECOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-27",
        "last_updated": "2012-03-27",
        "status": "A",
        "authorized_official_last_name": "WEST",
        "authorized_official_first_name": "LOUISE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "518-587-5304",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "NY",
            "license": "189300-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01877009",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Malta, NY · Obstetrics & Gynecology Physician in New York